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INTRODUCTION: This study aimed to determine the association between residing in municipalities with armed conflict and dental caries among adults in Colombia. METHODS: Data from 9,194 individuals aged 18-79 years, who participated in the Fourth National Oral Health Survey in 2014, were linked with information on the presence and intensity of the armed conflict experienced in their municipality of residence between 2000 and 2012 (extracted from the Resource Centre for Conflicts Analysis). Dental caries was determined through clinical examinations and summarised using the numbers of decayed teeth (DT), decayed and filled teeth (DFT), and decayed, missing, and filled teeth (DMFT). Two-level negative binomial regression models were fitted, with adults nested within municipalities, to test the association between armed conflict indicators and caries outcomes after adjustment for covariates. RESULTS: The mean DT, DFT, and DMFT scores were 1.75 (SD = 2.36), 6.03 (SD = 4.53), and 10.27 (SD = 7.11), respectively. Of the 197 municipalities included in the analysis, 12.2% experienced conflict permanently and 18.3% experienced high-intensity conflict. In crude analysis, adults living in municipalities with more presence and intensity of armed conflict had lower DT and DMFT, but not DFT scores. After adjustment for covariates, only the (high) intensity of conflict was associated with lower DT (rate ratio: 0.64; 95% confidence interval [CI]: 0.47-0.87), DFT (RR: 0.82; 95% CI: 0.71-0.95), and DMFT scores (RR: 0.81; 95% CI: 0.74-0.89). CONCLUSIONS: This study found that Colombian adults residing in municipalities with high intensity of conflict had lower levels of untreated disease and caries experience.

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The oral health-related quality of life of pregnant women and its effects on health conditions are important topics to be investigated in scientific research. The objective of this study was to evaluate the impact of pre-pregnancy obesity on oral health-related quality of life (OHRQoL) in pregnant women. A prospective cohort study was carried out with 93 pregnant women who were evaluated in the 2nd trimester of pregnancy (T1) and after delivery (T2). The following were analyzed: dental caries (DMFT), OHRQoL (OHIP-14), anthropometric data (BMI), socioeconomic, demographic, oral hygiene behavioral habits and the use of dental services. Unadjusted and adjusted Poisson regression analyses were performed to determine the impact of predictors on OHRQoL. The results of the adjusted analysis showed lower education relative risk (RR) (1.37; 95%CI 1.02-1.83; <0.00), low income (RR 2.19; 95%CI 1.63-2.93; <0.00) and higher BMI pre-pregnancy (RR 1.03; 95% CI 1.01-1.04; <0.00) were associated with worse OHRQoL in postpartum pregnant women. Flossing was a predictor of better OHRQoL at T2 (RR 0.73; 95%CI 0.57-0.93; <0.01). Higher BMI, low education, low income and inadequate oral hygiene habits were predictors of worse OHRQOL of pregnant women after the birth of the baby.

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Particulate matter is a type of air pollution that consists of fine particles with a diameter <2.5 µm (PM2.5), which can easily penetrate the respiratory system and enter the bloodstream, increasing health risks for pregnant women and their unborn babies. Recent reports have suggested that there is a positive association between PM2.5 exposure and adverse pregnancy outcomes. However, most evidence of this relationship comes from Western countries. Thus, the objective of this study was to evaluate the association between PM2.5 exposure during pregnancy and birth outcomes among pregnant women in Colombia. This study included 542,800 singletons born in 2019 to Colombian women, aged 15+ years, residing in 981 municipalities. Data on parental, child and birth characteristics were extracted from anonymized live birth records. Satellite-based estimates of monthly PM2.5 concentrations at the surface level were extracted for each municipality from the Atmospheric Composition Analysis Group (ACAG). PM2.5 exposure during pregnancy was indicated by the monthly average of PM2.5 concentrations across the pregnancy duration for the municipality where the child was born. The associations of municipality-level PM2.5 concentration during pregnancy with pre-term birth (PTB) and low birth weight (LBW) were tested in separate two-level logistic regression models, with babies nested within municipalities. The prevalence of PTB and LBW were 8.6 % and 8.3 %, respectively. The mean PM2.5 concentration across the 981 municipalities was 18.26 ± 3.30 µg/m3, ranging from 9.11 to 31.44 µg/m3. Greater PM2.5 concentration at municipality level was associated with greater odds of PTB (1.05; 95%CI: 1.04-1.06) and LBW (1.04; 95%CI: 1.03-1.05), after adjustment for confounders. Our findings provide new evidence on the association between PM2.5 on adverse pregnancy outcomes from a middle-income country.

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Background: Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru's healthcare system performance. Methods: Using estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region. Results: The Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8-70.3) to 80.3 (77.2-83.2) years. This increase was driven by the decline in under-5 mortality (-80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5-10.1) and reached 7.5 million (6.1-9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region. Conclusion: In the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.

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BACKGROUND: Vision and hearing impairments can reduce participation in social activities. Given the prominent role of the mouth in face-to-face interactions, this study evaluated the associations of tooth loss, vision, and hearing impairments with social participation among older adults. METHODS: This analysis included 1947 participants, aged 60+ years, who participated in three waves (2006, 2010, and 2015) of the Health, Wellbeing and Aging Study (SABE) in Brazil. Social participation was measured by the number of formal and informal social activities (requiring face-to-face interaction) participants were regularly involved in. Teeth were counted during clinical examinations and categorized as 0, 1-19, and 20+ teeth. Reports on vision and hearing impairments were classified into three categories (good, regular, and poor). The associations of each impairment with the 9-year change in the social participation score were tested in negative binomial mixed-effects models adjusting for time-variant and time-invariant covariates. RESULTS: Each impairment was associated with the baseline social participation score and the annual rate of change in the social participation score. Participants with 1-19 (incidence rate ratio: 0.96, 95% CI: 0.91-1.01) and no teeth (0.92, 95% CI: 0.87-0.97), those with regular (0.98, 95% CI: 0.95-1.01) and poor vision (0.86, 95% CI: 0.81-0.90), and those with regular (0.94, 95% CI: 0.91-0.98) and poor hearing (0.91, 95% CI: 0.87-0.95) had lower baseline social participation scores than those with 20+ teeth, good vision, and good hearing, respectively. Furthermore, participants with 1-19 (0.996, 95% CI: 0.990-1.002) and no teeth (0.994, 95% CI: 0.987-0.999), those with regular (0.996, 95% CI: 0.992-0.999) and poor vision (0.997, 95% CI: 0.991-1.003), and those with regular (0.997, 95% CI: 0.992-1.001) and poor hearing (0.995, 95% CI: 0.990-0.999) had greater annual declines in the social participation score than those with 20+ teeth, good vision and good hearing, respectively. CONCLUSION: This 9-year longitudinal study shows that tooth loss, vision, and hearing impairments are associated with reduced social participation among older adults.

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CONTEXT: Food insecurity affects approximately 2.37 billion people worldwide. Individuals experiencing food insecurity are more likely to exhibit poor health-related endpoints. Dental caries, a highly prevalent noncommunicable disease, is modulated by an interplay between biological, behavioral, and environmental factors. OBJECTIVE: This systematic review and meta-analysis aimed to assess whether individuals experiencing food insecurity were more likely to exhibit dental caries than individuals facing food security. DATA SOURCES: The Web of Science, PubMed, Scopus, Embase, Ovid, CINAHL, LILACS, and APA PsycINFO databases were checked from inception to November 2021. Grey literature and Google Scholar were also examined. An updated search was conducted in August 2022. Observational studies were included if they evaluated the association between dental caries and food insecurity status. DATA EXTRACTION: Data extraction was performed by two reviewers. DATA ANALYSIS: Random-effects meta-analyses were conducted using R language. In total, 514 references were retrieved from databases, of which 14 articles were included in qualitative synthesis and 7 were merged into meta-analysis. The results of an inverse-variance meta-analysis (OR = 1.62; 95%CI, 1.01-2.60) and a meta-analysis of binary data (OR = 1.66; 95%CI, 1.36-2.02) demonstrated that food-insecure individuals were more likely to exhibit dental caries than food-secure individuals. Inverse-variance meta-analyses appraising multiple strata of food security also showed that individuals experiencing marginal food security (OR = 1.48; 95%CI, 1.28-1.72), individuals experiencing low food security (OR = 1.26; 95%CI, 1.01-1.57), and those experiencing very low food security (OR = 1.33; 95%CI, 1.04-1.71) were more likely to exhibit dental caries than individuals experiencing full food security. CONCLUSION: Dental caries is associated with food insecurity. Individuals living with food insecurity are more likely to exhibit dental caries than those who have food security. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42021268582.

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OBJECTIVE: To cross-culturally adapt into the Brazilian Portuguese and evaluate the psychometric properties of an instrument for assessing the satisfaction of parents/guardians regarding their sons'/daughters' orthodontic treatment. METHODS: Translations of the instrument from English, pre-test and evaluation of validity and reliability of the Brazilian Portuguese version were performed. The questionnaire has 25 items distributed across 3 subscales (process, psychosocial effect and outcome). Eighty-three parents/guardians of children/adolescents who had completed orthodontic treatment participated. Descriptive statistics and floor and ceiling effects were calculated. Internal consistency, stability (interval of three weeks), convergent construct validity and discriminant construct validity were determined. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed dimensionality. RESULTS: Among the 83 parents/guardians, 58 (69.9%) were mothers and 25 (30.1%) were fathers of children/adolescents. In the questionnaire's total score and the three subscales scores, an acceptable percentage (≤15%) of participants achieved the maximum score (ceiling effect). In the total questionnaire score and in the three subscales scores, no participant achieved the minimum score (floor effect). Cronbach's α coefficient for the total score was 0.72 (internal consistency). Intra-class correlation coefficient for the total score was 0.71 (stability). The questionnaire's total score presented large Pearson correlation coefficient (>0.50) with the three subscales too (construct validity). Female parents/guardians had significantly higher scores in the psychosocial effect (p=0.013) and in the treatment outcome (p=0.037) subscales, compared to male parents/guardians (discriminant validity). EFA and CFA confirmed dimensionality in a three-factor solution. CONCLUSIONS: The final obtained version is valid and reliable to be used in Brazilian populations.

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OBJECTIVE: The objective of the study was to evaluate how gender, socioeconomic position (SEP), race/ethnicity and nationality intersect to structure social inequalities in adult oral health among American adults. METHODS: Data from adults aged 20 years or over who participated in the National Health and Nutrition Examination Survey (NHANES) 2009-2018 were analysed. The outcomes were poor self-rated oral health and edentulism among all adults (n = 24 541 and 21 446 participants, respectively) and untreated caries and periodontitis among dentate adults (n = 16 483 and 9829 participants, respectively). A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted for each outcome, by nesting individuals within 48 intersectional strata defined as combinations of gender, SEP, race/ethnicity and nationality. Intersectional measures included the variance partition coefficient (VPC), the proportional change in variance (PCV) and predicted excess probability due to interaction. RESULTS: Substantial social inequalities in the prevalence of oral conditions among adults were found, which were characterized by high between-stratum heterogeneity and outcome specificity. The VPCs of the simple intersectional model showed that 9.4%-12.7% of the total variance in the presentation of oral conditions was attributed to between-stratum differences. In addition, the PCVs from the simple intersectional model to the intersectional interaction model showed that 84.1%-97.1% of the stratum-level variance in the presentation of oral conditions was attributed to the additive effects of gender, SEP, race/ethnicity and nationality. The point estimates of the predictions for some intersectional strata were suggestive of an intersectional interaction effect. However, the 95% credible intervals were very wide and the estimations inconclusive. CONCLUSIONS: This analysis highlights the value of the intersectionality framework to understand heterogeneity in social inequalities in oral health. These inequalities were mainly due to the additive effect of the social identities defining the intersectional strata, with no evidence of interaction effects.

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AIMS: Increasing evidence supports a relationship between poor oral health and growth in children. Our objective was to assess the association between the presence of dental caries and anthropometric measurements of children residing in Claverito, a floating slum community in the Peruvian Amazon. METHODS: For this cross-sectional study, presence of caries was assessed using dmft/DMFT (decayed, missing, filled teeth) scores and the SiC Index (mean dmft/DMFT of one-third of the study group with the highest caries score). Anthropometric categories for age-sex-specific z-scores for height and weight were calculated based on WHO standardized procedures and definitions. The association between SiC (measured by dmft/DMFT) and anthropometric measures was estimated using unadjusted and adjusted multivariable linear regression models. Critical value was established at 5%. RESULTS: Our study population consisted of 67 children between the ages of 1 and 18 years old. Mean age was 9.5 years old (SD: 4.5), and the majority were female (52.2%). Almost all had dental caries (97.0%) and the mean dmft/DMFT score was 7.2 (SD: 4.7). The SiC Index of this population was 9.0. After adjusting for confounding variables, participants who had permanent dentition with the highest dmft/DMFT levels had statistically significant decreased height-for-age z-scores (HAZ) (p=0.04). CONCLUSIONS: We found an inverse linear association between SiC Index and height-for-age z-scores (HAZ) among children living in poverty in a floating Amazonian community in Peru. Children from under-resourced communities, like floating slums, are at high risk for oral disease possibly negatively impacting their growth and development.

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Abstract Aims: Increasing evidence supports a relationship between poor oral health and growth in children. Our objective was to assess the association between the presence of dental caries and anthropometric measurements of children residing in Claverito, a floating slum community in the Peruvian Amazon. Methods: For this cross-sectional study, presence of caries was assessed using dmft/DMFT (decayed, missing, filled teeth) scores and the SiC Index (mean dmft/DMFT of one-third of the study group with the highest caries score). Anthropometric categories for age-sex-specific z-scores for height and weight were calculated based on WHO standardized procedures and definitions. The association between SiC (measured by dmft/DMFT) and anthropometric measures was estimated using unadjusted and adjusted multivariable linear regression models. Critical value was established at 5%. Results: Our study population consisted of 67 children between the ages of 1 and 18 years old. Mean age was 9.5 years old (SD: 4.5), and the majority were female (52.2%). Almost all had dental caries (97.0%) and the mean dmft/DMFT score was 7.2 (SD: 4.7). The SiC Index of this population was 9.0. After adjusting for confounding variables, participants who had permanent dentition with the highest dmft/DMFT levels had statistically significant decreased height-for-age z-scores (HAZ) (p=0.04). Conclusions: We found an inverse linear association between SiC Index and height-for-age z-scores (HAZ) among children living in poverty in a floating Amazonian community in Peru. Children from under-resourced communities, like floating slums, are at high risk for oral disease possibly negatively impacting their growth and development.

Resumo Objetivos: Há cada vez mais evidências apoiando uma relação entre a saúde bucal precária e o crescimento das crianças. Nosso objetivo foi avaliar a associação entre a presença de cárie dentária e medidas antropométricas de crianças residentes em Claverito, uma comunidade flutuante de favelas na Amazônia peruana. Métodos: Para este estudo transversal, a presença de cárie foi avaliada utilizando os escores dmft/DMFT (dentes cariados, ausentes, preenchidos) e o Índice SiC (média dmft/DMFT de um terço do grupo de estudo com a maior pontuação de cárie). As categorias antropométricas para pontuações z específicas de idade e sexo para altura e peso foram calculadas com base nos procedimentos e definições padronizados da OMS. A associação entre SiC (medido por dmft/DMFT) e medidas antropométricas foi estimada usando modelos de regressão linear multivariável não ajustados e ajustados. O valor crítico foi estabelecido em 5%. Resultados: A população do estudo consistia de 67 crianças entre 1 e 18 anos de idade. A idade média era de 9,5 anos (DP: 4,5), e a maioria era do sexo feminino (52,2%). Quase todas tinham cárie dentária (97,0%) e a média da pontuação dmft/DMFT foi de 7,2 (DP: 4,7). O índice SiC desta população era de 9,0. Após ajuste para variáveis confusas, os participantes que tinham dentição permanente com os níveis mais altos de dmft/DMFT tinham diminuído estatisticamente a pontuação z de altura por idade (HAZ) (p=0,04). Conclusões: Encontramos uma associação linear inversa entre o Índice SiC e as pontuações z de altura por idade (HAZ) entre crianças que vivem na pobreza em uma comunidade amazônica flutuante no Peru. Crianças de comunidades com poucos recursos, como favelas flutuantes, correm alto risco de contrair doenças orais, possivelmente impactando negativamente seu crescimento e desenvolvimento.

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ABSTRACT Objective: To cross-culturally adapt into the Brazilian Portuguese and evaluate the psychometric properties of an instrument for assessing the satisfaction of parents/guardians regarding their sons'/daughters' orthodontic treatment. Methods: Translations of the instrument from English, pre-test and evaluation of validity and reliability of the Brazilian Portuguese version were performed. The questionnaire has 25 items distributed across 3 subscales (process, psychosocial effect and outcome). Eighty-three parents/guardians of children/adolescents who had completed orthodontic treatment participated. Descriptive statistics and floor and ceiling effects were calculated. Internal consistency, stability (interval of three weeks), convergent construct validity and discriminant construct validity were determined. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed dimensionality. Results: Among the 83 parents/guardians, 58 (69.9%) were mothers and 25 (30.1%) were fathers of children/adolescents. In the questionnaire's total score and the three subscales scores, an acceptable percentage (≤15%) of participants achieved the maximum score (ceiling effect). In the total questionnaire score and in the three subscales scores, no participant achieved the minimum score (floor effect). Cronbach's α coefficient for the total score was 0.72 (internal consistency). Intra-class correlation coefficient for the total score was 0.71 (stability). The questionnaire's total score presented large Pearson correlation coefficient (>0.50) with the three subscales too (construct validity). Female parents/guardians had significantly higher scores in the psychosocial effect (p=0.013) and in the treatment outcome (p=0.037) subscales, compared to male parents/guardians (discriminant validity). EFA and CFA confirmed dimensionality in a three-factor solution. Conclusions: The final obtained version is valid and reliable to be used in Brazilian populations.

RESUMO Objetivo: Adaptar transculturalmente para a língua portuguesa do Brasil e avaliar as propriedades psicométricas de um questionário que avalia a satisfação de pais e responsáveis com relação ao tratamento ortodôntico recebido por seus filhos. Métodos: Tradução do questionário em inglês, pré-teste e avaliação da validade e confiabilidade da versão em português obtida. O questionário consistiu de 25 itens distribuídos em três subescalas (processo durante o tratamento, efeito psicossocial e resultado geral do tratamento). Participaram 83 pais/responsáveis de crianças/adolescentes que concluíram o tratamento ortodôntico. Estatística descritiva foi realizada e foi calculado valor máximo e valor mínimo. Foram determinadas a consistência interna, a estabilidade (intervalo de três semanas), a validade de constructo convergente e a validade de constructo discriminante. A análise fatorial exploratória (AFE) e a análise fatorial confirmatória (AFC) avaliaram a dimensionalidade. Resultados: dos 83 pais/responsáveis que participaram do estudo, 58 (69,9%) eram mães e 25 (30,1%) eram pais das crianças/adolescentes. No escore total do questionário e no escore das três subescalas, uma porcentagem aceitável (≤15%) dos participantes atingiu o escore máximo (ceiling effect). No escore total do questionário e no escore das três subescalas, nenhum participante atingiu o escore mínimo (floor effect). O coeficiente α de Cronbach para o escore total foi 0,72 (consistência interna). O coeficiente de correlação intraclasse para o escore total foi 0,71 (estabilidade). O escore total do questionário apresentou um coeficiente de correlação de Person alto (>0,50) com as três subescalas (validade de constructo). Pais/responsáveis do sexo feminino apresentaram escores significativamente maiores nas subescalas efeito psicossocial (p=0,013) e desfecho do tratamento (p=0,037), em comparação aos pais/responsáveis do sexo masculino (validade discriminante). AFE e AFC confirmaram a dimensionalidade em uma solução de três fatores. Conclusões: A versão do questionário obtida no presente estudo mostrou-se válida e confiável para o uso na população brasileira.

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AIM: To investigate the within- and between-person longitudinal effects of tooth loss and the use of dentures, clinically assessed by dentists, on cognitive decline in a representative sample of community-dwelling older Brazilian adults. METHODS: Data came from 1265, 1112 and 1021 individuals aged ≥60 years who participated in the second (2006), third (2010) and fourth (2015) waves, respectively, of the Health, Well-being and Aging study (SABE). Cognitive performance was evaluated with the abbreviated version of the Mini-Mental State Examination (MMSE). The number of natural teeth was classified according to three categories: none, 1-19 and ≥20 teeth. The presence of removable full or partial dentures in each dental arch (yes/no) was recorded. Hybrid regression models, adjusted for sociodemographic, behavior and health-related covariates, were used to estimate the between- and within-person effects of the longitudinal association between cognitive performance and oral health. RESULTS: Participants with 1-19 and no teeth had, respectively, 1.15 (95% CI 0.65-1.66) and 1.54 (95% CI 0.99-2.09) units lower MMSE score than those with ≥20 teeth. Denture wearers had 1.54 (95% CI 1.13-1.95) units greater MMSE score than non-denture wearers, and those who started wearing dentures during the follow up had 0.83 (95% CI 0.21-1.45) units greater MMSE score after the transition. CONCLUSION: Our main findings showed that the use of dental prostheses might be a protective factor for cognitive decline. Geriatr Gerontol Int 2021; 21: 1093-1098.

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OBJECTIVE: There is little evidence of the association between complete tooth loss and allostatic load (AL). We investigated, firstly, the association between complete tooth loss and changes in AL for 12 years among older English adults. A second aim was to explore the role of fruit and vegetable consumption in explaining the aforementioned association. METHODS: AL was calculated for 2430 English Longitudinal Study of Ageing cohort (2004/5-2016/17) participants 50 years and older based on nine biomarkers: systolic and diastolic blood pressures, glycated hemoglobin, high- and low-density lipoprotein cholesterol, triglycerides, fibrinogen, C-reactive protein, and waist circumference. The exposure was complete tooth loss. Participants were classified as dentate or edentulous. A linear mixed-effects model was fitted to model the 12-year change in AL score and its association with complete tooth loss after adjustments for confounders (demographic factors, socioeconomic position, and health behaviors). RESULTS: Around 11% of the participants were edentulous. Complete tooth loss was positively associated with baseline AL scores but not with its rate of change over time. The predicted mean AL scores were 3.60 (95% confidence interval [CI] = 3.53-3.68) and 3.98 (95% CI = 3.76-4.21) as well as 4·28 (95% CI = 4·18, 4·39) and 4·66 (95% CI = 4·42, 4·90) for dentate and edentulous participants, at baseline and end of follow-up, respectively. Fruit and vegetable consumption was not associated with baseline AL or its rate of change. CONCLUSIONS: Complete tooth loss was associated with baseline AL score but not with its development over time, whereas the consumption of fruit and vegetables did not help to explain this association. Both conditions may share common determinants earlier in life.

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OBJECTIVE: To investigate the rate and associations of interproximal carious lesion progression. METHODS: Retrospective data were analysed from 125 young adults (age range: 18-29 years) with repeated bitewing radiographs collected over a 6-year period. Participants were submitted to different protocols of radiographic examination frequency. Transitions from outer enamel to outer dentine (OE-to-OD) and from outer dentine to dentine (OD-to-D) were selected because of their clinical relevance. Factors associated with each transition were assessed in Cox regression models. RESULTS: One hundred seven (85.6%) and 52 (41.6%) participants experienced OE-to-OD and OD-to-D transitions, respectively. In addition, 16.8% of 537 eligible surfaces progressed from OE-to-OD whereas 59.4% of 128 eligible surfaces progressed from OD-to-D. Incidence rates were 6.6 and 44.1 per 100 tooth surface-years, respectively. Mean survival time for OE-to-OD transition was 6.4 years (95% confidence interval: 6.0-6.9) and the median survival time for OD-to-D transition was 1.6 years (95%CI: 1.3-1.7). In adjusted Cox regression models, location in the lower jaw (hazard ratio: 0.34; 95% CI: 0.21-0.57) was inversely associated with OE-to-OD progression. In addition, proximal DMFS at baseline (HR: 0.93; 95%CI: 0.87-0.99) and location in the lower jaw (HR: 0.51; 95%CI: 0.26-0.99) were inversely associated with OD-to-D progression. CONCLUSIONS: This group of Chilean young adults has a high progression rate of proximal caries lesions. Location of the caries lesion and proximal DMFS were the only factors associated with caries progression.

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The aims of this study were to assess factors associated with catastrophic healthcare expenditure (CHE) and the burden of out-of-pocket (OOP) payments for specific healthcare services in Peru. We used data from 30,966 households that participated in the 2016 National Household Survey (Encuesta Nacional de Hogares, ENAHO). Participants reported household characteristics and expenditure on ten healthcare services. CHE was defined as healthcare spending equal to or higher than 40% of the household's capacity to pay. The associations of various household characteristics and OOP payments for specific healthcare services with CHE were assessed in logistic regression models. Poorer, rural and smaller households as well as those with older adults and individuals with chronic conditions had greater odds of facing CHE. According to the estimates from the adjusted regression model, healthcare services could be grouped into three groups. Medical tests, surgery and medication were in the first group with odds ratios (ORs) between 6.43 and 4.72. Hospitalisation, outpatient, dental and eye care were in the second group with ORs between 2.61 and 1.46. Child care, maternity care and other healthcare services (such as contraceptives, rehabilitation, etc.) were in the third group with non-significant ORs. Many Peruvian households are forced to finance their healthcare through OOP payments, burdening their finances to the extent of affecting their living standards.

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INTRODUCTION/OBJECTIVE: A systematic review was conducted to explore whether tooth loss affects dietary intake and nutritional status among adults. DATA: Longitudinal studies of population-based or clinical samples of adults exploring the effect of tooth loss on food/dietary/nutrient intake and/or nutritional status were included for consideration. The risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies. SOURCES: A search strategy was designed to find published studies on MEDLINE, EMBASE and LILACS up to March 2017. STUDY SELECTION: Eight longitudinal studies in 4 countries (United States, Japan, Australia and Brazil) were included. Five of the six studies investigating the association between tooth loss and dietary intake showed significant results. The only consistent association, as reported in 2 studies, was for greater (self-reported) tooth loss and smaller reductions in dietary cholesterol. Three of the 4 studies investigating the association between tooth loss and nutritional status showed significant results. However, most results were contradicting. The quality of the evidence was weak. CONCLUSION: There is at present no strong evidence on the effect of tooth loss on diet and nutrition, with inconsistent results among the few studies identified. Additional high-quality longitudinal studies should address the limitations of previous studies identified in this review.

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BACKGROUND: Poor oral health has been associated with some components of frailty. The objective of this study was to identify the association between clinical measures of oral health and the incidence of frailty among community-dwelling older adults aged 70 or older in Mexico City. METHODS: A 3-year cohort study with a probabilistic representative sample of home-dwelling elders of one district of Mexico City was performed. Baseline and follow-up interview and oral clinical evaluations were carried out by standardized examiners in participants' homes. Dependent variable was incident frailty defined according to the frailty phenotype. Independent variables were the utilization of dental services, the presence of xerostomia, the number of natural teeth, use of removable dental prostheses, presence of severe periodontitis, and presence of root remnants. Sociodemographic, behavioral, and health measures were included as confounders. The association between oral health conditions and incident frailty was modeled using Poisson regression models with robust variance estimators. The models were adjusted for confounders and interactions. RESULTS: We identified a 14.8% cumulative incidence of frailty. Each additional tooth was associated with a lower probability of developing frailty by 5.0% (risk ratio = 0.90; 95% CI 1.02-1.10). The 3-year risk ratio of developing frailty was 2.13 times higher (95% CI 1.01-4.50) among participants having severe periodontitis. CONCLUSIONS: The number of teeth and the presence of severe periodontitis are associated with the development of frailty after controlling for confounders. Further studies are needed on this topic.

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BACKGROUND: Several longitudinal studies have explored the association of obesity and weight gain with periodontal disease. However, the effect of weight loss on periodontal tissues remains unclear. OBJECTIVE: To explore whether weight loss after bariatric surgery was associated with changes in periodontal measures over 12 months. SETTING: Two public hospitals in São Paulo, Brazil. METHODS: We used data from 110 morbidly obese patients (body mass index [BMI]>40 kg/m2 or≥35 kg/m2 with co-morbid conditions) who underwent bariatric surgery between April 2011 and March 2013. Data on demographic factors, BMI, smoking habits, and glucose levels were extracted from medical records preoperatively and after 6 and 12 months postsurgery. A full-mouth periodontal examination was conducted by trained examiners to assess probing pocket depth, clinical attachment loss, and bleeding on probing (BOP) at baseline and 6 and 12 months after surgery. Data were analyzed using linear mixed-effects models. RESULTS: BMI was not significantly related to the proportion of sites with BOP at baseline, but it was negatively associated with the rate of change in the proportion of sites with BOP. The greater the BMI loss, the higher the proportion of sites with BOP, particularly 6 months after surgery. However, BMI was not associated with baseline probing pocket depth and clinical attachment loss or rates of changes in these periodontal outcomes. CONCLUSION: The findings suggest that weight loss was associated with increased gingival bleeding, showing a peak at 6 months after bariatric surgery. Periodontal pocketing and attachment loss remained unchanged during the study period.

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OBJECTIVE: To compare self-esteem scores in 12 to 16-year-old adolescents with different Angle malocclusion types in a Peruvian sample. MATERIAL AND METHODS: A cross-sectional study was conducted in a sample of 276 adolescents (159, 52 and 65 with Angle Class I, II and III malocclusions, respectively) from Trujillo, Peru. Participants were asked to complete the Rosenberg Self-Esteem Scale (RSES) and were also clinically examined, so as to have Angle malocclusion classification determined. Analysis of covariance (ANCOVA) was used to compare RSES scores among adolescents with Class I, II and III malocclusions, with participants' demographic factors being controlled. RESULTS: Mean RSES scores for adolescents with Class I, II and III malocclusions were 20.47 ± 3.96, 21.96 ± 3.27 and 21.26 ± 4.81, respectively. The ANCOVA test showed that adolescents with Class II malocclusion had a significantly higher RSES score than those with Class I malocclusion, but there were no differences between other malocclusion groups. Supplemental analysis suggested that only those with Class II, Division 2 malocclusion might have greater self-esteem when compared to adolescents with Class I malocclusion. CONCLUSION: This study shows that, in general, self-esteem did not vary according to adolescents' malocclusion in the sample studied. Surprisingly, only adolescents with Class II malocclusion, particularly Class II, Division 2, reported better self-esteem than those with Class I malocclusion. A more detailed analysis assessing the impact of anterior occlusal features should be conducted.

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ABSTRACT Objective: To compare self-esteem scores in 12 to 16-year-old adolescents with different Angle malocclusion types in a Peruvian sample. Material and Methods: A cross-sectional study was conducted in a sample of 276 adolescents (159, 52 and 65 with Angle Class I, II and III malocclusions, respectively) from Trujillo, Peru. Participants were asked to complete the Rosenberg Self-Esteem Scale (RSES) and were also clinically examined, so as to have Angle malocclusion classification determined. Analysis of covariance (ANCOVA) was used to compare RSES scores among adolescents with Class I, II and III malocclusions, with participants' demographic factors being controlled. Results: Mean RSES scores for adolescents with Class I, II and III malocclusions were 20.47 ± 3.96, 21.96 ± 3.27 and 21.26 ± 4.81, respectively. The ANCOVA test showed that adolescents with Class II malocclusion had a significantly higher RSES score than those with Class I malocclusion, but there were no differences between other malocclusion groups. Supplemental analysis suggested that only those with Class II, Division 2 malocclusion might have greater self-esteem when compared to adolescents with Class I malocclusion. Conclusion: This study shows that, in general, self-esteem did not vary according to adolescents' malocclusion in the sample studied. Surprisingly, only adolescents with Class II malocclusion, particularly Class II, Division 2, reported better self-esteem than those with Class I malocclusion. A more detailed analysis assessing the impact of anterior occlusal features should be conducted.

RESUMO Objetivo: comparar os escores relacionados à autoestima de adolescentes com 12 a 16 anos de idade, portadores de diferentes tipos de má oclusão de Angle, em uma amostra de peruanos. Métodos: um estudo transversal foi conduzido com uma amostra de 276 adolescentes (159, 52 e 65, respectivamente, com má oclusão de Classe I, II e III de Angle) da cidade de Trujillo, Peru. Os participantes foram instruídos a completar a Escala de Autoestima de Rosenberg (Rosenberg self-esteem scale, ou RSES), e também foram submetidos a exames clínicos para determinar qual sua má oclusão, segundo a classificação de Angle. A análise de covariância (ANCOVA) foi utilizada para comparar os escores da RSES dos adolescentes com más oclusões de Classes I, II e III, controlando-se os fatores demográficos dos participantes. Resultados: as médias dos escores da RSES dos adolescentes com Classes I, II e III foram, respectivamente: 20,47 ± 3,96, 21,96 ± 3,27 e 21,26 ± 4,81. O teste ANCOVA revelou que o escore da RSES dos adolescentes com Classe II foi significativamente maior do que o escore dos adolescentes com Classe I, mas não houve diferenças entre os outros grupos de más oclusões. Uma análise adicional sugeriu que podem ser somente os adolescentes Classe II, subdivisão 2, que apresentam autoestima mais elevada, quando comparados aos adolescentes Classe I. Conclusão: esse estudo mostrou que, no geral, a autoestima dos adolescentes incluídos na amostra estudada não variou em função da má oclusão apresentada. Inesperadamente, apenas os adolescentes com Classe II - especialmente os com Classe II, subdivisão 2 - relataram apresentar uma autoestima mais elevada do que os adolescentes com Classe I. Uma análise mais detalhada deve ser conduzida, avaliando qual característica oclusal da região anterior tem mais impacto.

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